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24 GLENDALE ST - BUILDING INSPECTION (3) i; -7 — LK 180 5 The Commonwealth of Massachusetts �ISPEGTIONAL RVI� OF Board of Building Regulations and Stan& s SALEM Massachusetts State Building Code, 780 CMRm � ��`` S l� ALA Building Permit Application To Construct, Repair,Renovate`C7t�Te�ne 12a' *tpNar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: / 1.2 Assessors Map&Parcel Numbers 2�1CnlCy40.� S, W Lla Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(it) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone?Check ifyes0 Municipal❑ On site disposal system [I SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of ggg�cord: S)p CU n !�"r ram- k sS 211 Mo-,v W 2 o d ►� r� (`f 7 S' Name(Print) City,State,ZIP l3`t ad a ,4;C Ave . --M-639- 0077 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) E� Addition ❑ Demolition ❑ Accessory Bldg. ❑ 1 Number of Units I Other ❑ Specify: Brief Description of Proposed Work': v.5-I-o,L c�R.o.r- vi t -IN i vt.&c,'.v S SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 6. 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costs(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ Lt, 7 3(o- 0Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) O S7—i-i 3 1 Ck y-; S —2-0 y— License Number Expiration Date Name of CSL Holder ' �- No ✓ T+ List CSL Type(see below) No.and Street Type Description S i �A p U Unrestricted(Buildings u to 35,000 cu.ft. --e R I 1G R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding G �1 SF Solid Fuel Burning Appliances ` 7 7 b��-'y I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) AA -r-V cR s 1�C HIC Registration Number Expiration Date HIC CompM Name or HIC Registrant Name No75 k q Street Email 0&l C b 1 ��0 1�'�...! �f h1 Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize ��l/t,✓ -S ZO I"L�! to act on my behalf,in all matters relative to work authorized by this building per it application. !! = A co 2 `I �- t Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information containe t thi application is true and accurate to the best of my knowledge and understanding. /A-/ Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass. ov/oca Information on the Construction Supervisor License can be found at www.mass.sov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of halfibaths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" A&A SERVICES,INC. - �- 1805 City of Salem 2/18/2014 5000 Cost of Goods Sold:5115 Permits Pingree-Russell Window Permit 40.00 A&A Beverly Coop 63 Permit: Pingree-Russell Windows 40.00 DISPOSAL OF DEBRIS AFFIV 111T . In accordance with the provisions ®g M. Go L. c. 40, S= 54, a cond Hon 6' Building PsMif$f%ambaP is$Fiat the debris resuring 6r�r�this Wo,k shall be lisp seed ®f:ia a properly.floansed faoifffy as defa9®d.by ft G. L.00 The debris w0l be diSPDSed at'. Owned by f prftWa Carga igna$ars ®l Pd�i ®ptican$ iVaM ®f���rui8�p�6i�ae6 . A &A SgMti ap, Inc Rim 6 HEM &6PaGE Salem. MA 01970 Addm� s, C!4� S$pL% 7fp Coda The Commonwealth of Massach usetts kvDepartment of Industrial Accidents Office of Investigations 600 Washington Street .� Boston, MA 02111 sY www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):�,� Address:)/5 nJo�—� 1� Sr, City/State/Zip: 4 yvN M t9" O 1 4 7 o Phone#: q Are u an employer?Check the appropriate box: [2. [am a employer with4. ❑ I am a general contractor and I Type of project(required): employees(full and orparttime).* have h red the sub-contractors 6. ❑New construction❑ I-am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: 9. ❑ Building addition required.] 5. ❑ We are a corporation and its l0.❑Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.❑ Plumbing repays or additions myself..[No workers' comp, right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.[1 Other comp.insurance required.] Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I a n an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-uns. Lic. #: a M g l Expiration Date: Job Site Address (�\ F i1-�ctl� S+. City/State/Zip �g,ey Attach a copy the workers'compensation poucy., �tion page(showing the policy num her and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify it the p ' s and penaLies-ofperjuty that the infornattion provided jjabov/e/iiss true and correct 5 nature: fDate_! Phone#: q 1 [ ^ �( a ---------------------------- F on(p. I)n no[write in[Lis area, to be completed by city or town officialn: Permit/License# hority(circle one): Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector son: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MOIL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses..A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Conunonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFC Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia Federal BIN:04-3090162 Construction Supervisor No.GS057733 WINDON'S AND STORNJ PRODUCT SPECIFICATION SITEET' , Br"(.)Name Date of Comren SNgP-mJ �iNGQ - VySe� Z- 12-1y euymis)sweat Addict,Ce,SIZIe end zip Cane J:n /+oaa�3�': 24 4c core I61L ST SH-e1 m,a-0ly70 139 �TL✓yv T/ C Avcs iti7R213L�H e?3D Mq o/yy5— DaAnne Telephone amen., Evening Telephone Number Moblla Telephone Number EMen AEdreas 70/-�l0- yotvo The 9uyer0 howal aWve noun,pinlly antl seventh,agiee re pwchase Ins goys ea.,weavers III cast,In annraenta and the press and Inm50a5rnea On this Specification sheet and the Imnl and the merae of the acebmpanyny CRSTOM REMODELING AND IMPROVEMENT AGREEMENT of which Inis Spoolicetron sheet is a Pan, WINDOW REPLACEMENT Remove and disease of 8 existing wi99or ws Insan x�— new sLs/C-35 Air windows:6inyl twooa (Menu acW ter Options: Style 1)14 grid pattern l� ACoto,Inter,., dLHult Colo,Exterior W''l II- class Type�J(LE unA/-u O-Wrap swede,trim with aluminum: Style Color � dr N2tc"a SAvO Q All windows will he installed Aerate,an the installation procedures In the portfolio. ©Caulk all inert.,antl exterior foi �T Insulate where possible around new units. l " Insulals window weight pockets It exist,and arountl new window units where possible. ` I Included in this proposal are set up,clean up,Hepa vacuum and cleaning windows inside and out. t Building permit Included. BAY I,BOWS I CASEMENT UNITS I ANY FULL CONSTRUCTION WINDOWS t Create new window opening by cutting through existing home and framing in opening. _ ♦ Remove and dispose of existing units)In its entirety Note:Electric and plumbing may exist in wall and will require additional costs 10 customer It need to be dead with. 1 Install windows)into Resnince), Note: If Bay or Bow Installation to include cable support system,new roof system(morning color as close as possible) or to into existing soffit system. t Bav t Bow t Casement T Other windows)to include new interior style vim and new exterior style trim and head flashing as neetled. Note: Painting and staining not included. STORM PRODUCTS i Remove and dispose of N existing storm wtndowhe). I Install new storm armadas Air Manutaduret Style Color Option t Remove and dispose of be existing storm doogs). T Install new sbrm game p Manutadid er Style Color Type: t Aluminum t Said Core SPECIAL INSTRUCTIONS. Federal EIN 04-3090162 G0rSIwCD0n Supervisor No.C5b57733 : ' CUSTOM REMODELING AND I MPROV EMENTAGREEM ENT ' au PizI•VI NkL Q LIt T-n, + rvAme2� IN R"eZ? - /IGUsS e"t L- Gata�cu/2_! ao ,al sveet aeamaa.cd.sdla arms coee "� '+-vr�; zy 4e0 v9nc-tT sttp,.ti .+terl 11F70 l3 9 BT'U+iI.�� /><v�r -J'7n/3LCs7jz-Y}p n-f!� o�S Yf Da hoe Tele umher Eveni TO bee Numhe, Mohile Tde bee NumOe, E Mail Pharess 761-4135-0 7� 78/—�Ja—'nbo s!°iN .zc s�C) Trip 6uye,lsl lu ea a.,xi nweby lume Ana svve,allV aB,ev a pumlrase tl,e gSds e,glu'servees Isteo on Ire anr�unpa^yirg spetirulgn meets,in acw,panm yan Na mcas and reins aes head on Ire Imnl aan me reverse d In¢moss m ano any andel tin sems.Nis'Apreemenl'1,ab.....ouma) m osee no. oun 1.loosprcdsmynce head indallee ercem,at al auyere edaress ds4d ahpre.pflAServtles,Inc.l'L'mnscra(1,nareny ag,eesb mslallwrause,o he insUYea tl,e pmdutls or servkes I61etl In Nis Ag,remenl al me auyvHsl addeye aniaen aEeve.iltis Pg,eemenr represen,s a wzn sale Of gads ana se,vicve.Tne.mellid eg,ee to pay m tasn Ne cusl al Ine ponds eM cerv'us purcnasep as aeso'raM nwem,regaNless d,vning o,apWwal of any linanciy auye,aj may seeF for rhea puornaee. s Pwdnse Price: �73� Est coming Dare:3-12 3-3 / W roan Payment JJ 71�, Ed.curroman Dma.3-3.1'1`/ amwn me an Sian of Jae: wan g Dneet method Due on_d completer: zf�"a�i'f`751813Ofj aueud Dan an d.—Hi on- 3! Expiated D.S. eadza one Or Upon eundenon: eve code HRM 3 u Is ag,aae aua anaerAooe or and onae¢r lee panes roar mro Agreo:mont o-o,LL aa_Cacx aua auv aeearaam,aunawme In.mird— n. .alaaeina havieer me IaaNea,and mere ne uo veAal unaanuneiuga margin"^o modiyine any tree terms W Six Athuma d.euywlq ,mv ar:xarawlee9p tom 6uyer(s)nm mad me nod ana ma,everse rat lnla.meamem ana lus,xeivea a compreWa,vienea era aatae ropy rat tnls Agnmedd,mcludrae me two atlmLea Notice of Curtailment bane,an me date ma. ..tta need;.eu.-it.youed man(r)eaxaoimal a tlut they.Ineand orally Iraomree of mmr Nem b ceucel cols h.uvmam.na fil,.wam m.nnev ee canuctee via melnmapnora runners o,enail,.a talod Bowe d mo Arad CONTAINS day 81- euySPA wwla Le interest;;in eny additional quality prwducls a service;of Contractor.00 NOT SIGN THIS CONTRACT IF IT CONTAINS ANy nes SPACES. A&A Senlces, ne.y�,�L Em�erls) 6y' ,M SlgnaWre Signature Pent Name XGrT4PAN {(� fir rkrz-i: .RUSS_LL Print Name Signature Print Name You,the Buyer(s),may cancel this therat than at any time prior to midnight of the third business day after the date of this transaction.See the following Notice of Cancellation form lot an explanation of this right, want ae, s uw a.�'anrepn cu e:.1 a I"amwrs1.—irructeux. 4 v oyp� e LL.,­x,. m,ewnwmswmmwn1L 10 1a'Feme. ea�I'ohnro ka.a ne, dussaI.Ionw,, ealHe'cnove awer,I.i.ae,dca,arat.. wwy�.ran,,uOs, mr . xv laurawym m an,mWners sewv n pax rew -a—mrwmn ea whennsa,m,enypoms.1heeewyvrrwah eonveaw5ue,vrwumsv.evdnx -IwweemrItionw — wIt he coo,wrn me wuewmv or ter scw,IBadrq ae,ewn viipmr m tee la'w,n ma Svua a wu xe rnauwwms a me sebr,waenp he reran sniprvnr er tee pops s me Seems '�;."'y'9+ :TV-,g ITNP y*,+rt, ,� rtr. 1 0'X._ ;�, .+ St.f .3P'r `�xa . +, r, s._ ,.- f THE COMMONWEALTH OF MASSACHUSETTS _ EXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT DEPARTMENT OF LABOR STANDARDS 19 STANIFORD STREET,BOSTON,MASSACHUSETTS 02114 DELEADER CONTRACTOR LICENSE A&A SERVICES, INC. 115 NORTH STREET.,. SALEM MA 01970 LICENSE DC000440 EXPIRES:,Saturday,June:07,2014 IN ACCORDANCE-WITH CH. 111, § 9 97B(b)AND 454 CMR 22 03;,THIS LICENSE IS•ISSUED BY THE D_EPARTMEN OF LAB OR STANDARDS TO THE CONTRACTOR:ABOVE FOR THE PURPOSE OF ENTERING INTO OR ENGAGING IN DELEADING WORK, THIS LICENSE IS VALID FOR A PERIOD OF ONE YEAR. THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR WHEN ENGAGED IN DELEADING WORK IN ACCORDANCE WITH M.G.L. CH; 111 § 197B0)(2)AND 454 CMR 22.03. HEATHER.E.ROWE,DLRECTOR Q u e rpammaaxrae¢�l/a�,P/�laauacLerrae in( Massachusetts -Department of Public Safety 11, Office ofCousumerAffafrs�eBusifiessRegutatiou Board of Building Regulations and Standards OME IMPROVEMENT CONTRACTOR Construction Supercisnr '* egistration 1g1609 Type: License: CS-057-733 xpiration 6126Y261A Private Corporatio ':, a j � r r� cMUSTOPBERZORZY" A&A SERVICES INt : n t _ - S G - 115 NORTH ST " _ Salem N A 01970- Christopher Zorzy :..,. 115 North Street c—' Expiration Salem,MA 01970 Undersecretary -�-�`°""' 05126/2015 j Commissioner ,3j1 0lNGA RFOf .INC'. r 1 rmc R i Sus - N.7Advanced Training , ti ialj My 1202' ' jProgramz Y. ­'4 (ar;) 1?4-12,4 h, 1 Fiber Cement Sidin I x Christopher Zorzy t120120426000840 ' A&A Services Inc Exp 4/26/2017 srT r .Ty�, 115 North St bPl CiiP1S zaa� ; t ca �.o =tom a sa_ Salem, MA 01970 —" Matthew J',Glbson r . i 30_ 9 ' Phone: 978-741-0424 A&A SE Fax: 97 p www.a-aservices.cices.com 115 North Street Salem,MA 01970 February 18, 2014 City of Salem Building Dept. 120 Washington Street Salem, MA 01970 To Whom It May Concern: Enclosed please find the permit/app i ation for Sharon Pingree-Russell, 24 Glendale St. #1, Salem, MA to replace windowsi. I have enclosed a check fbr$40 based o�your fee schedule of$7 per$1,000.00 plus a $5 administrative fee. The total for the job was $4,736.00. Please send the completed permit to A& A Services,Inc. at II-5-North Street, Salem, MA 01970. If you have an" uestion' s, lease contact me at 978) 741-'0424. Y �Y9 please � Thank you,for your Sincerely, / Barbara Zorzy Office Managercl